The AAP has guidelines for simple febrile seizure – “There, there, the frightening demonic possession your child just experienced is nothing to worry about.” Complex febrile seizures, however, are offered far less conclusive guidance.
This little retrospective review from UC San Diego evaluates 193 patients presenting with complex febrile seizure. Lumbar puncture was performed in 136, and 1 patient ultimately received a diagnosis of bacterial meningitis. The authors suggest, cognizant of the limitations, that complex febrile seizures need not routinely undergo LP.
This is entirely reasonable and consistent with the prior literature. The largest retrospective review, from Boston Children’s, identified 3 cases with bacterial meningitis out of 526 children. A systematic review and meta-analysis identified 41 cases of bacterial meningitis out of 1996 children. There are additional cases of viral meningitis and encephalitis in these cohorts as well – of uncertain clinical significance – but the general implication is that otherwise well-appearing children ought not need LP absent other signs of CNS infection.
It would, of course, be fabulous if a consensus guidelines would further reinforce this evidence.
“Necessity of Lumbar Puncture in Patients Presenting with New Onset Complex Febrile Seizures”
www.ncbi.nlm.nih.gov/pubmed/23687537
“Yield of lumbar puncture among children who present with their first complex febrile seizure.”
www.ncbi.nlm.nih.gov/pubmed/20566610
“Risk of bacterial meningitis in young children with a first seizure in the context of fever: a systematic review and meta-analysis.”
www.ncbi.nlm.nih.gov/pubmed/23383133